Intended Date of Use: ______/______ to ______/______

I understand that a non-refundable postage and handling fee of $5.00 per title must be remitted. All music must be returned as borrowed or I will reimburse the M.G.C.M.E.A. for any music that has been lost or damaged. Music that has not been returned within two weeks after the date of use will be considered lost and restitution will have to be made.

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Director’s Signature                                                 Date